The patient population
Changing population demographics in the UK mean the prevalence of neurodegenerative diseases and many other neurological disorders is increasing. Prompt diagnosis and intervention can help to identify the likely health and social impacts of the disease at an early stage, and thereby avoid hospital admissions, and reduce the negative effect on quality of life for both patient and carer where possible.
Improving the management of the more common disorders that affect younger people, such as migraine and epilepsy would also have a major public health impact. Migraine is ranked globally as the seventh most disabling disease among all diseases (responsible for 2.9% of all years of life lost to disability) and the leading cause of disability among all neurological disorders. It is estimated that the UK population loses 25 million days from work or school each year because of migraine. Severe migraine attacks are classified by the World Health Organization as among the most disabling illnesses, comparable to dementia, quadriplegia and active psychosis.
The following datasets on the prevalence of neurological diseases in the population are also useful sources of information on the local population for planning services:
- Public Health Profiles, Public Health England
- National Mental Health, Dementia and Neurology Intelligence Network
- Commissioning for Value Programme, NHS England
- Secondary Uses Service (SUS), Health and Social Care Information Centre
- Community Information Data Set (CIDS), Health and Social Care Information Centre
- GP clinical systems
Prevention of disease
Historically, the specialty of neurology has been specifically concerned with the diagnosis of neurological disorders. During the last 20–30 years there has been a revolution in the treatment of many conditions, some of which were previously considered untreatable (eg stroke and multiple sclerosis). Neurologists are now turning their attention to health promotion and disease prevention.
- Encouraging patients to manage their own conditions more effectively, eg migraine (see NICE commissioning guidance, opens PDF, 129.56KB).
- Developing management guidelines to enable GPs to more effectively manage patients with migraine and epilepsy.
- Promoting healthy living and exercise to delay the onset and progression of neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease.
- The FAST campaign to rapidly identify stroke to enable thrombolysis therapy to be given in a timely fashion.
- Using the ABCD2 score to identify those TIA patients at high risk of stroke.
- Increasing the awareness of the potential teratogenicity of anticonvulsant medication.
- Recognising patients with epilepsy who are at high risk of SUDEP (sudden unexpected death in epilepsy).
- Zero tolerance of recurrent generalised seizures to prevent hospital admission.
- Increasing awareness of the health risks of smoking, alcohol and drug misuse including nitrous oxide.
- Improving genetic counselling for hereditary neurological disorders.
- Reducing the risk of head and spinal injury by encouraging the use of cycle helmets and lanes.
- Vaccination for meningococcal meningitis.
Planning effective services
Despite an overall increase in the commissioning of neurology services, there continue to be low numbers of neurologists compared with other developed countries. There is also a need for seamless commissioning of the whole patient pathway, regardless of setting. Thames Valley Strategic Clinical Network has recently produced a neurology commissioning brief for community neurology services, which provides information on delivering high-quality integrated services.
Referral to treatment targets have distorted services so that although waiting times for new patient referrals have reduced, there is a disincentive for services to see follow-up patients, which negatively impacts on the care of people with long-term neurological conditions (see the Association of British Neurologists Commissioning Toolkit 2016, opens PDF, 413.29KB)
Large variations in the quality of commissioning of neurological services among clinical commissioning groups were highlighted in the Neurological Alliance’s report The Invisible Patients. A recent progress review (opens PDF, 574.59KB) of services to people with neurological conditions by the Public Accounts Committee acknowledged the inadequate commissioning of neurology services,
There also needs to be an improvement in the commissioning of acute neurology services as identified in a recent survey (opens PDF, 254.46KB) by the Association of British Neurologists.